Your Appeal Rights
If your initial claim for disability benefits is denied and you disagree with this decision, you can appeal.
There are several levels of appeal:
- Administrative Appeals (non-adversarial)
- Reconsideration
- Hearing before an administrative law judge
- The Appeals Council
- Appeals to Federal Court (adversarial)
- United States District Court
- United States Court of Appeals
If a party to a case disagrees with a decision of a U.S. Court of Appeals, they can appeal to the United States Supreme Court. Because a very low percentage of cases appealed to the U.S. Supreme Court are ever heard, we will not consider this level of appeal here.
You cannot skip appeal levels. Thus, you cannot appeal to the Appeals Council unless your case has been considered by an Administrative Law Judge first, and you generally cannot ask for an Administrative Law Judge hearing unless your case has been reconsidered first. In a few states, by the way, the appeals process may be different; please call us at 1-800-819-8123 for more information.
Reconsideration
The first step in appealing a case is to file a Request for Reconsideration. You must file this request within 60 days of the date that you received the initial decision. The Social Security Administration generally presumes that you received their decision 5 days after the date printed on it, but there are exceptions to this rule. To be safe, file the request less than 60 days after the date printed on the decision letter. You can file this first appeal yourself:
- Download the form, fill it out, sign it, and mail it, or
- file your appeal directly on the Social Security Administration website. If you have trouble filing online, then call the Social Security Administration at 1-800-772-1213, Monday through Friday between 7:00 a.m. and 7:00 p.m.
You can contact a lawyer for assistance, but you need not wait for the lawyer to take your case before you file the appeal. If your claim was denied 30 to 65 days ago you should stop and file the appeal now.
According to information on the Social Security website you can also request an appeal by calling the Social Security Administration at 1-800-772-1213, Monday through Friday between 7:00 a.m. and 7:00 p.m.; however, we strongly recommend that you appeal either in writing or online.
If you miss the appeal deadline, you can either file a new application or you can file your appeal with a request for extension (known as a “good cause” letter); you can also do both. Filing a new application is not a substitute for appealing; failure to appeal on time can cause you to lose benefits.
Supporting documentation you must provide
If the initial denial decision was for medical reasons – which is the most common situation – then in addition to filing the appeal, you must complete a new Disability Report and a new medical records release form (SSA-827). If you have a lawyer, you will need to fill out two kinds of medical records release: the SSA-827 which allows the Social Security Administration to obtain your medical records, and another form that allows your lawyer to obtain your records; the latter form can be obtained from your lawyer.
If you aren’t able to file the disability report and the medical records release before the deadline, or if you need time to gather more information, file the Request for Reconsideration first and then file the disability report and medical records release forms later. If you submit the appeal on time but not the disability report or medical records release forms, the Social Security Administration will consider your appeal as timely filed and will ask you for the supporting documentation. After they ask, you generally have ten days to submit it.
If your initial decision was denied for non-medical reasons, then call us for information on what supporting documentation is required.
In summary
If the initial decision was wrong, always appeal. Be sure to file the request for reconsideration appeal on time, and don’t forget to complete the supporting documentation.
What happens after you file your reconsideration request?
First, the Social Security Administration will check to see if your appeal was filed on time. If it was filed on time, the Social Security Administration will then check to see whether your initial claim was denied for medical or non-medical reasons, and whether your paperwork is complete.
If your initial claim was denied for non-medical reasons (for example, you applied for Social Security Disability Insurance and you don’t have enough work credits, or if you applied for SSI and you have too much money), the reconsideration will be done within the Social Security Administration district office.
If it was denied for medical reasons (they thought your disability wasn’t severe enough) and your paperwork is complete, the case will be sent back to the disability determination service (DDS). If the paperwork is not complete, they will attempt to contact you to request the required supporting documentation, then they will send the case to the DDS.
If the appeal was not filed on time, the Social Security Administration will make a decision on whether you had “good cause” for late filing; call us for more information.
Most initial denials are for medical reasons. After a request for reconsideration is sent to the disability determination service for your state, it will be assigned to a different adjudicator, who will review your case file including any new evidence that you submit or that the adjudicator obtains. (The adjudicator is supposed to contact any doctors you list on the Disability Report form, and any other doctors whose contact information you or your lawyer provide.) The DDS will likely mail a notice asking you to visit a doctor who will examine you at government expense; this is known as a “consultative examination” (CE).
If you visit your own doctor before receiving this notice, you can also ask whether he or she is willing to do a CE, and if your regular physician is willing and you are our client, you can contact us at 1-800-819-8123 so we can see if we can get the DDS to use your treating physician for this purpose. We strongly advise all clients to make their best effort to cooperate with the consultative examination, as the doctor who performs the examination will attempt to assess your credibility.
In addition, if the doctor is thorough, then he or she may detect a condition that was not diagnosed earlier by your regular physician; if this happens, the DDS should be notified, and this can support your claim. If the doctor doing the examination is not your regular doctor, we recommend you ask the examining doctor to provide a copy of his or her report to your primary-care physician, as this may be useful for treatment purposes.
If you can’t attend the consultative examination, please contact the phone number on the notice provided by the DDS; if you are our client, you can contact us as well.
After reviewing the new evidence you provide, along with the results of any consultative examination, the DDS adjudicator and a medical consultant other than the one who handled your initial claim will then decide the case. (The medical consultant will also not be the same individual who did the consultative exam.) This medical consultant has decisionmaking authority regarding the medical severity of your condition (steps 2 and 3 of the five-step process for determining disability); the DDS adjudicator performs the rest of the adjudication.
After the Disability Determination Service makes a decision, the Social Security Administration may review and can modify it before notifying you. Congress has mandated that at least half of all favorable decisions be reviewed.[1] The Social Security Administration will then mail the decision to your last known address.
The appeals process may be different in some parts of the country. Call us at 1-800-819-8123 for more information.
By the way, it is important that you keep the Social Security Administration and your lawyer (if you have one) informed of any changes to your address. Otherwise, the appeal deadline may pass before you learn of the decision in your case.
Next: The Hearing Stage
